Enhancing ICU Patient Care Through Pain Management Case Study

Assignment Task

Brief description 

A 48-year-old gentleman admitted to ITU following post laparotomy. He has got the past medical history of Cholecystectomy. Patient was on ventilator with propofol and fentanyl infusions. On his 2nd postoperative day, I received the handover that he became agitated, tachycardic, tachypnoeic, hypertensive and his oxygen demand was increased in general, especially soon after repositioning or any other clinical interventions. During my patient assessment I noticed that patient was noncompliant with ventilator and hypertensive. Checked ABG -hypoventilation. Increased to FiO2 level. Tried to reassure and make him settle by talking and staying with him by holding his hands but unable to make him comfortable. Completed behavioural pain assessment on both rest and movement (CPOT-rest and action) and it appeared to be in severe pain. Informed the nurse in charge and the ACCP. Received advise to increase the sedation and wait for the next ward round. But despite increasing the sedation patient did not settle, myself took initiative and bleeped the ITU doctor to review the pain management. Meantime I discussed the situation with patient’s wife, about his previous medications and checked the previous medical records in detail and noted that he was on regular pain killers after his previous Cholecystectomy. I informed this to the NIC and ICU doctor and they agreed that the pain management could be ineffective, and they have changed the Fentanyl infusion to Remifentanil and prescribed regular IV paracetamol four times a day. Patient appeared settled with this treatment change and his oxygenation status improved and became compliant with ventilator care. After two days patient was extubated. Then I met the patient prior to his ward transfer, and he was very thankful about the whole team when he understood about his ITU stay from his wife and the ICU treatment diary.

Important points to consider/aspects to reflect on for analysis: 

• Behavioural pain scale and pain assessment-the Critical Care Pain Observation Tool (CPOT)
• Prevention, early pain detection and management
• Agitation in postoperative ventilated patients.

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